Clark Rachel K, Trethewy Christopher E
Gosford Hospital Emergency Department, Gosford, New South Wales, Australia.
Emerg Med Australas. 2005 Aug;17(4):376-81. doi: 10.1111/j.1742-6723.2005.00760.x.
To assess the accuracy of cricoid force applied by ED staff working in two hospitals based on the New South Wales central coast.
A prospective, observational study of 38 doctors and 69 nurses working in the ED. Each staff member was asked to demonstrate cricoid pressure using a model based on a set of weighing scales. Five attempts were measured and a mean value calculated for each participant. Subgroup analysis was also performed for specific variables of interest.
Twenty-seven (25%) participants applied the target cricoid force. Of the 80 participants who were outside of the target range, 50 (63%) applied less than the target range and 30 (37%) applied more than the target range. No statistically significant difference was demonstrated for sex, age, qualification or years of experience and the ability to apply cricoid force within the target range. More candidates (27) applied the target range than those who correctly identified it (12). When methods of instruction were compared there was no difference between candidates with one and more than one modality of instruction (t-test: t (105) = -0.09, P = 0.9; 95% confidence interval [CI]-0.66-0.6) and the mean cricoid force applied. Those who had greater than one form of instruction applied correct cricoid force at the target range more often than those who had received only one form of instruction, this result was significant. (chi(2) = 4.24, d.f. = 1, P = 0.04; odds ratio = 2.6; 95% CI 1.03-6.41).
The application of cricoid force by ED staff participating in the present study is unreliable, often providing inadequate protection against regurgitation. Training using a model integrating the concept of force is recommended. The role of cricoid pressure in rapid sequence induction needs to be further investigated.
评估新南威尔士州中部海岸两家医院急诊科工作人员施加环状软骨压迫力的准确性。
对急诊科的38名医生和69名护士进行一项前瞻性观察研究。要求每位工作人员使用基于一套称重秤的模型演示环状软骨压迫。测量五次尝试的结果，并为每位参与者计算平均值。还对感兴趣的特定变量进行了亚组分析。
27名（25%）参与者施加了目标环状软骨压迫力。在80名超出目标范围的参与者中，50名（63%）施加的压力小于目标范围，30名（37%）施加的压力大于目标范围。在性别、年龄、资质或工作经验以及在目标范围内施加环状软骨压迫力的能力方面，未显示出统计学上的显著差异。施加目标范围压力的参与者（27名）比正确识别目标范围的参与者（12名）更多。比较指导方法时，接受一种及多种指导方式的参与者在施加环状软骨平均压力方面没有差异（t检验：t(105)= -0.09，P = 0.9；95%置信区间[CI]-0.66 - 0.6）。接受多种指导方式的参与者比仅接受一种指导方式的参与者更常在目标范围内正确施加环状软骨压迫力，这一结果具有显著性（卡方检验= 4.24，自由度= 1，P = 0.04；优势比= 2.6；95% CI 1.03 - 6.41）。
参与本研究的急诊科工作人员施加环状软骨压迫力的操作不可靠，通常无法提供足够的防反流保护。建议使用整合了压力概念的模型进行培训。环状软骨压迫在快速顺序诱导中的作用需要进一步研究。
